We initially developed a preliminary conceptual framework based on the existing historical and well documented facts about Iranian history of medicine, followed by a systematic review of Persian and English literature to identify sentinel events or breakthroughs for inclusion in this paper. We then searched PubMed, Google Scholar, and Scientific Information Database (an Iranian database), without any time period limitation and using different combinations of the following search terms
ReviewIran in transition
Introduction
Iran is a Middle Eastern country that has been governed as an Islamic republic since 1979. However, based on archaeological findings, the history of civilisation in the Iranian plateau is more than 5000 years old,1 and the establishment of a sovereign state in Iran has a history of approximately 3000 years. During this lengthy past, similar to many other ancient civilisations, many great scientists and physicians have emerged from Iran who have contributed substantially in expanding medical knowledge, which was inextricably intertwined with mathematics, philosophy, and theology in the old ages. Some of these physician-philosophers had a major role in keeping the scientific torch alive during the Dark Ages until it was handed over to the Renaissance era pioneers.2, 3 The unique expansion of science and medicine in Iran might be attributed to several factors, such as the importance of learning and propagation of science in Iran (both before and after the Islamic conquest of the country in the 7th century AD) and its geographical proximity to ancient Greece, India, China, the Islamic empire, as well as being located on the Silk road, which was not only a route for economic trades but also led to cultural interactions between Iran and countries of east Asia and east Europe.
In this Review, we discuss the health system and the health status in Iran from ancient times and describe its challenges during those periods. We highlight the present challenges and hurdles of the Iranian health system, and conclude by outlining the actions and policies required to address these obstacles as well as present a framework of activities to engage the community, health authorities, and other sectors to maintain the sustainable development in health.
Section snippets
Iran in brief
Iran is one of the ancient civilisations, historically known as Persia, that has had a relatively continuous existence as a sovereign state over the millennia. According to Herodotus, an ancient Greek historian born in the Persian empire, Deioces established the first Iranian Government in Ecbatana (contemporary Hamadan and Biblical Acmeta) in the 7th century BCE through forging unity among different local tribes.4 Contemporary Iran has an area of 1 648 195 km2 (636 372 square miles), occupying
Development of health care and medicine in ancient Iran and the Middle Ages
Iran is one of the oldest civilisations in the world and its history of medicine and public health interventions date back to ancient times. Medical and health-care practices and rituals have been recorded in ancient Iranian texts, such as Avesta (the holy book of the Zoroastrian religion and an old Iranian encyclopaedia dating to the 5th century BCE).14 In Avesta, ancient Iranian physicians' classes and ranks have been described, and details of medical practices and ethical considerations of
Health status and major social determinants of health in recent history
During the past two centuries, Iran has gone through many different sociopolitical events, which has affected the health status of the nation (figure 3). At the start of the 19th century, Iran's population was about 5 million, which increased to about 9 million by early 1900s, and most of the population inhabited the rural areas.31 This period coincided with the reign of the Qajar Dynasty (1794–1925), during which, despite some efforts aimed at improving the health of the nation, the general
Environmental and ecological changes and their effects on population health
Iran's population nearly tripled from 18 million to 38 million over the three decades preceding the revolution (1950–79). Although Iran's relatively high fertility rate plummeted from 6·5 births per woman to 1·72 because of a successful family planning campaign between 1985 and 2016, the population stood at 80 million in 2016 (figure 4),47 the majority consisting of working age adults in urban areas. The proportion of the population living in urban areas increased from less than 30% in 1950 to
Development of formal structures for the health system
Back in 1881, the first official health institution in Iran, called the Sanitary Council, or Majles-e Hefz al-Sehheh (the Council for Preservation of Health) was founded with the goal of systematically organising and directing efforts toward improving the public health status and combating fatal disease epidemics.33 The Sanitary Council operated under the auspices of the Ministry of Interior until 1920, when the Ministry of Health and Charity Affairs was officially launched and the
Development of medical knowledge and education
Although traditional medicine was taught in religious education centres (Howza) for centuries, the Dar al-Fonun School (House of Techniques), established in 1851, was the first modern higher educational institute that had a medical department in Iran (figure 5). Before the establishment of Dar al-Fonun, traditional physicians were the sole medical practitioners in Iran and there were no approved rules and regulations for medical practice in the country.66 Before 1860, when Iranians joined the
Development of public health and infectious disease control strategies
Development of public health in Iran has previously mainly focused on controlling infectious diseases (figure 6), and only recently have actions been directed towards addressing the increasing burden of non-communicable diseases. In the mid-19th century, Amir Kabir launched the first national initiative to address a serious public health concern of the time and to control infectious diseases through implementation of a national smallpox vaccination campaign, which was made into a law by the
Development of the primary health-care network
During the past century, Iran has attained remarkable achievements in addressing nationwide inequity and the provision of primary health services to its rural areas. Remote and rural areas have always had a severe shortage of health professionals because of their reluctance to work in these areas. In 1950, the Regional Director of the WHO's Eastern Mediterranean Regional Office estimated that in Iran, there was only one physician per 60 000 of the population.91 This shortage of health
Improving access to secondary and hospital care
Hospitals have a long history in Iran.21 However, the history of modern hospital care dates back to the time of the Qajar dynasty (1785–1925), when Qajar kings frequently travelled to Europe and adopted similar measures in Iran. During this period, hospitals also had a prominent role in the propagation of western knowledge of medicine across Iran, especially in major cities.102 However, expansion of hospital beds was sluggish and hospitals were seldom built in small towns.103 Up to 1916, three
Mental disorders and developments in mental health care
Before the 1940s, mental health services were characterised by large mentally ill shelters with poor conditions. The establishment of new psychiatric hospitals and departments in the 1950s and psychiatric training since the 1960s resulted in improvement of services to psychiatric patients.119 The Rouzbeh mental hospital followed by the Tehran Psychiatric Institute were pioneers of delivering modern psychiatric services and training in the country.
While the establishment of the primary
Youth risks and behaviour
Iran's population is mostly consisted of young people, so the health status of this group can affect the health of the entire population both now and in the future. Additionally, society has had social shifts (mostly due to the rapid uptake of tertiary education, the increasing roles of women in communities, globalisation, and the expansion of information, technology, and urbanisation), which has made remarkable changes in the lives of the young people living in Iran. This social shift is why
Development of health financing and risk protection
The social health insurance programme in Iran began in 1974, with the main objective of providing health insurance coverage to the whole nation. However, the early years of the programme was marred by inadequate planning and fiscal viability, a problem that has continued to this date.141 Many years later, in 1995, efforts to provide universal health insurance were revived through the passing of a new legislation. However, the programme had little success in improving access to hospital care
Health transition during the past century
The population size in Iran has increased by nearly four times over the past 60 years, with an older-age structure and has had decreases in the annual population growth by half during this period (figure 7).151, 152 The transitional trends of the sociodemographic measures over these years in Iran, in addition to several economic and scientific achievements, have resulted in improvements in health indices (table).153, 154
Similar to most other developing countries in the 20th century,
Call to action
Since the establishment of the Iranian constitution in 1910, provision of primary health-care services has always been an obligation of the state and all citizens have been entitled to benefit from free-of-charge primary health services.39 During the past century, the Iranian health system has earned important achievements in terms of provision of health services with particular success in controlling infectious diseases and decreasing child and adult mortality.172 Given the political
Search strategy and selection criteria
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